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Pediatric Gastroenterology Fellowship

The primary goal of the program is to train academic pediatric gastroenterologists. We define academic gastroenterologists as those who are excellent clinicians encompassing skills in broad aspects of evaluation, diagnosis and management of primary and secondary diseases of the gastrointestinal tract and who are active in advancing the field by participating in research and/or education.

The first year of the program is devoted principally to clinical training, with both inpatient and outpatient activities and participation in an active consult service. The second and third years of the program are devoted primarily to laboratory and/or clinical research. In some cases, an additional year may be added for training in clinical nutrition.

An independent three-year Nutrition fellowship is available. For those applicants interested in pursuing a traditional GI fellowship with additional Nutrition training, a combined four-year program is available. This program requires admission to each individual program and is comprised of the GI clinical year, a Nutrition clinical year and then the two-year research experience with a project that spans both fields.

First year

Inpatient service

Goals: As described in the guidelines provided by the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), the fellow should become competent in rendering age-appropriate inpatient care from evaluation to discharge of a broad range of gastrointestinal diseases, including intestinal mucosal diseases, motility disorders, hepatobiliary diseases, pancreatic disorders and functional problems from mouth to anus. Furthermore, the fellow should become competent in the performance of diagnostic and therapeutic invasive procedures. The fellow should learn to evaluate and ameliorate the psychosocial impact of disease, utilize available ancillary services and deliver cost efficient care.

Objectives: The fellow will participate, with supervision from attending physicians, in all aspects of the care of patients of all ages hospitalized under the GI service at Children's Hospital. This care includes initial evaluation, formulation of differential diagnosis and evaluation, participation in diagnostic procedures, interpretation of laboratory, radiologic, pathologic and other testing, treatment and discharge planning. The fellow will perform daily duties as described in the Fellows Handbook. The fellow will also participate in teaching residents and students on rounds and at the bedside. The fellow will attend all teaching conferences.

Outpatient service

Goals: As described in the NASPGHAN guidelines, the fellow should become competent in rendering age-appropriate outpatient care from evaluation through long-term follow up or discharge from clinic as indicated for each disease process. The fellow should provide care to patients with a broad range of gastrointestinal diseases including intestinal mucosal diseases, motility disorders, hepatobiliary diseases, pancreatic disorders and functional problems from mouth to anus. Additionally, the fellow should learn to evaluate and ameliorate the psychosocial impact of disease, utilize available ancillary services and deliver cost efficient care.

Objectives: The fellow will, with supervision from attending physicians, organize outpatient evaluation, diagnostic procedures and treatment, including hospital admissions as necessary. The fellow will perform history and examination, review of outside data and present cases to the attending physician as per the Fellows Handbook. The fellow will generate a clinic note and dictate a letter to the referring physician.

Consult service

Goals: The fellow should become proficient in the evaluation of primary and secondary gastrointestinal signs and symptoms in infants and children with non-GI disease. This includes primary GI diseases in those patients with extraintestinal presentations and secondary GI diseases in patients with known non-GI diseases. The fellow should be able to perform a complete history and examination and review any prior medical evaluation and testing. Formulations and recommendations must be reviewed with the supervising attending physician and then communicated to the referring team and placed in the patient record in a timely and respectful fashion.

Objectives: The fellow will evaluate all patients as requested by any primary service at the Hospital. The fellow will present cases, write notes and communicate with the primary service as per the Fellows Handbook. The fellow will attend and make presentations in rotation at all teaching conferences.

Procedure service

Goals: The fellow should become increasingly proficient in the performance of various GI invasive procedures including patient assessment, sedation, procedural techniques and post-procedure monitoring and management. The fellow will ultimately develop skills to become independently proficient in diagnostic procedures such as upper and lower endoscopy, rectal suction biopsy, liver biopsy and manometry. The fellow will gain experience in therapeutic procedures including esophageal dilation, sclerotherapy, banding and polypectomy.

Objectives: The fellow will review charts of scheduled outpatient procedures daily, will participate in the consent process, conscious sedation, the procedure, post-procedure management, communication with patients and families and generation of reports.

Additional rotations

Goals: The major goal of these rotations is to provide additional experience and insight into other specialties important to the evaluation and treatment of children with GI disorders, particularly Nutrition, Radiology and Pathology. The fellow will attend Continuity Clinic and participate in teaching conferences as allowed by the selective schedule.

Objectives:

Nutrition — The fellow will spend a one-month rotation on the Nutrition service and will participate in various nutrition clinics (cystic fibrosis, renal disease, weight management (obesity), home total parenteral nutrition, etc.). The fellow will learn to perform nutritional evaluation, generate TPN formulations and interpret various nutritional tests, including bone densitometry, body composition testing and other specialized testing as determined by the nutrition service.

Radiology — The fellow will spend two weeks on rotation in the Department of Radiology observing fluoroscopic procedures, ultrasound and interventional radiology techniques. The main objective is for the fellow to gain an appreciation of the dynamic nature of the studies that is lost on review of the static images. The fellow will not perform these procedures.

Pathology — The fellow will spend two weeks on rotation in the Department of Pathology observing processing techniques and reviewing all GI case material submitted during that period. The main objective is for the fellow to view numerous biopsy specimens daily and to see multiple normal biopsies with the pathologists. A minor objective is for the fellow to gain a general understanding of the processing techniques and how specimen collection impacts the outcome of the processing.

Night and weekend call

Goals: The goal of night and weekend call is to provide the fellow with experience in the telephone triage of patients with acute changes in new or chronic illness and to provide training in cross-covering inpatients.

Objectives: The fellow will obtain sign-out information from the inpatient and/or consult fellow as applicable prior to taking on-call responsibilities. Responsibilities are described in the Fellows Handbook.

First-year clinical rotations

Approximately 12 weeks inpatient service

Approximately 12 weeks consult service

Approximately eight weeks outpatient service

Approximately eight weeks procedure service

Four weeks nutrition

Two weeks pathology

Two weeks radiology

Four weeks vacation

One-half day a week dedicated to the outpatient clinic

Second and third years

Research experience

Goals: Each fellow will undertake a specific project or projects — under the guidance of a clinical mentor — with the goal of significant participation in research. This is one of the requirements of the American Board of Pediatrics for certification in Pediatric Gastroenterology, the NASPGHAN guidelines and our program goal to produce graduates who will become academic gastroenterologists. The division chief and program director will assist each fellow in the selection of an appropriate project and mentor.

Objectives: The specific objectives of each project will vary greatly depending on the project selected and the mentor chosen. The long-term goal is for each fellow to submit at least one manuscript describing their research experience to a peer-reviewed journal for publication. The fellow will attend project specific conferences and the standard clinical GI conferences.

Outpatient service

Goals: See First year, Outpatient service

Objectives: See First year, Outpatient service

Night and weekend call

Rigorous laboratory and/or clinical research training under the guidance of faculty in the division, other divisions of the Hospital and other departments of the University of Pennsylvania and its School of Medicine

Research training supported by the division, including a NIH training grant in Gastrointestinal Sciences held jointly with the adult GI section

Research projects selected during the first year under the guidance of the research fellowship director and other mentors

Outstanding research environment, including these areas of investigation in the division:

Molecular biology of the enteric nervous system

Central nervous system control of gastrointestinal function

Immunology of the intestinal tract and abnormalities in inflammatory bowel disease

Opportunities for research training in state-of-the-art laboratories at affiliated institutions, including the Departments of Medicine, Biochemistry, Genetics, Microbiology, Pathology and Laboratory Medicine and Physiology at the University of Pennsylvania School of Medicine and the Wistar Institute

High publication output and placement in academic positions for fellowship graduates

Weekly

Pathology conference

Interesting biopsy results from the previous week are presented on an overhead screen by a pediatric pathology faculty member.

Outpatient clinic conference

Rotating schedule of Journal Club, research presentations and combined discussions with various services, including Radiology, General Surgery, Nutrition, Pulmonology and Allergy/Immunology.

Clinical case conference

Presentation of an interesting case by the fellow to the GI divisions of Children's Hospital and the Hospital of the University of Pennsylvania. Following the case presentation, there is a discussion of disease epidemiology, pathophysiology and treatment. Both adult and pediatric GI fellows participate in this conference.

GI lecture series

Pediatric Grand Rounds

GI Grand Rounds

Nutrition lecture series

Nutrition journal club

Surgical Grand Rounds

Digestive and liver disease research seminar

Special programs

The three-year fellowship seeks physicians who will have completed two to three years of training in an accredited residency program in order to sit for the American Board of Pediatrics certifying examination.

Parts 1, 2 and 3 of the USMLE, taken within the 7-year time frame as required by the Commonwealth of Pennsylvania, or equivalent scores

If a graduate of a medical school outside the United States, Canada or Puerto Rico, valid ECFMG certificate or one that does not expire prior to the start of the fellowship

If not a citizen of the United States or permanent resident, a copy of current, appropriate visa will be required.

The fellowship director reviews completed applications. Selected candidates will then be invited to interview.

National Resident Matching Program (NRMP)

Our fellowship program participates in the National Resident Matching Program (NRMP). To learn more, visit NRMP, or contact the program at 202-828-0676.

Tobacco-free hiring policy

To help preserve and improve the health of our patients, their families and our employees, The Children’s Hospital of Philadelphia has a tobacco-free hiring policy. This policy applies to all candidates for employment (other than those with regularly scheduled hours in New Jersey) for all positions, including those covered by the Collective Bargaining Agreement.

Job applicants who apply after July 1, 2014 will be expected to sign an attestation stating they’ve been free of nicotine or tobacco products in any form for the prior thirty (30) days. They will also undergo a cotinine test as a part of the Occupational Health pre-placement drug screen administered after the offer of employment has been accepted but before the first day of hire.

Exemptions: Attending physicians (excluding CHOP physicians in the Care Network), psychologists, principal investigators and/or Penn-based faculty are exempt from this process to better align with our colleagues at the University of Pennsylvania Perelman School of Medicine.